BACKGROUND: A GP – Dr K – is a partner in a small village practice and is at home on an afternoon off when the receptionist calls from the surgery. A patient – Mr L – has phoned the practice wishing to speak with him in regard to an urgent personal matter. The receptionist passes on a contact number and the GP phones Mr L, whom he knows well both from the surgery and through casual contact in the village.
Mr L is very angry. Just that morning he was phoned by a good friend who had been in the local pub the night before and heard it discussed that Mr L’s daughter was in rehab for a drug addiction. Dr K says he is sorry to hear this but asks how it is a “personal matter”. Mr L states that his daughter – though a registered patient – is rarely in the village, and no-one locally could know about her drug problem apart from Dr K. He accuses the GP of either discussing the matter at home or elsewhere in the village and that this constitutes a serious breach of confidentiality. The GP comes off the phone very upset and calls the senior partner.
That afternoon Mr L phones the surgery again and asks to speak to the practice manager – Ms D. He repeats his allegation of breach of confidentiality and states that he wants to make a formal complaint. The practice manager asks Mr L to put this in writing so the matter can be investigated. Ms D then speaks with Dr K and the receptionist who took the initial message, asking them to write a statement setting out their versions of the events. Dr K is adamant that he never discusses matters involving patients outside of the surgery – and working in such a small community makes him even more scrupulous.
The next day Mr L hand-delivers his letter into the surgery and the practice manager phones MDDUS for advice. A medico-legal adviser asks her to forward anonymised copies of both the complaint and the GP’s account of the events. He also advises Ms D that consent will be required from Mr L’s daughter before the practice can respond to the complaint. Ms D acknowledges receipt of the Mr L’s letter and sets out the need for patient consent.
ANALYSIS/OUTCOME: MDDUS offers advice on the wording of the response to Mr L’s complaint and Ms D drafts a letter for review. In the letter she expresses regret at what has transpired in regard to his daughter. She then provides details of her investigation into the alleged breach including discussions with the receptionist and with Dr K. She states that the GP is again adamant that he was not the source of the gossip circulating around the village. Having worked many years in a small community he knows how any discussion of patient details with family or friends can lead to confidentiality breaches – even if inadvertent. For this reason he is particularly scrupulous in not discussing patients outside the practice team.
Ms D concludes the draft letter by stating that her investigation has led her to believe the information regarding Mr L’s daughter must have come from another source in the village. She offers to meet with the patient and Mr L face-to-face, along with Dr K, and informs him that if they are not satisfied with the outcome of the complaint process it is their right to take up the issue with the ombudsman (and she provides contact details).
The MDDUS adviser reviews the letter and again reminds Ms D that before she can send out the response she must obtain consent from the patient – Mr L’s daughter. She advises the practice manager to write to Mr L informing him that the investigation is complete and that she would be pleased to forward it to him upon receipt of the signed consent.
A month later Ms D contacts MDDUS to say that she has not yet received a letter of consent from Mr L’s daughter permitting disclosure of the investigation, despite having written twice. The adviser replies that it is now reasonable to write to Mr L informing him that as consent has not been provided she is now required to close the complaint. But the practice manager is advised to ensure she keeps the papers in a complaints file as the usual timescale for raising cases under the ombudsman is 12 months after the incident, though this can be extended in extenuating circumstances.
- Maintaining patient confidentiality requires scrupulous professionalism especially in a small community.
- Ensure a third party has consent (or parental responsibility) to act on behalf of a patient in pursuing a complaint.
- Patient consent will also normally be required before the results of a complaints investigation can be shared with a third party.